This newborn presents with neonatal tetanus, which could have been readily prevented by prenatal vaccination of the mother with a tetanus-toxoid vaccine.
Tetanus is caused by the tetanospasmin toxin, which causes spastic paralysis by preventing the release of inhibitory neurotransmitters glycine and GABA in the spinal cord. Tetanus can be prevented by vaccination with a toxoid vaccine, which is made from formaldehyde-inactivated tetanus toxoid. The primary means of preventing neonatal tetanus infection is by vaccination of women of childbearing age. The vaccine induces the production of IgG immunoglobins, which can cross the placenta, thereby protecting the newborn baby.
Murphy et al. discuss the acquisition and prevention of neonatal tetanus. Tetanus is caused by the spores of the organism Clostridium tetani. These spores are commonly found in the environment. The spores gain access to the body through disruptions in the skin. The spores germinate in oxygen-poor environments and the resulting bacteria produce the characteristic tetanus toxin. Neonatal infection with tetanus is typically acquired through contamination of the umbilical stump. Symptoms typically begin within a few days to two weeks of life. Patients initially present with irritability and feeding difficulties, as in the question above. The fatality rate of the disorder is high; survivors may have permanent neurological damage. Treatment consists of supportive care.
Khan et al. discuss the prevention of neonatal tetanus. Several interventions may help to prevent the disorder, but the most important intervention is vaccination of women of child bearing age with tetanus toxoid vaccine. Additional interventions that reduce the risk are delivery in a clean environment with skilled care and appropriate care and hygiene of the umbilical cord stump.
Figure A depicts an infected umbilical stump, which would been seen in neonatal tetanus infection which was acquired via the umbilical cord. Illustration A depicts the arching body rigidity seen in neonatal tetanus.
Answer 1: The tetanus vaccine is not a conjugated polysaccharide vaccine, nor is vaccinating a child at birth likely to provide immediate protection against infection.
Answer 3: Injection of vitamin K at birth can prevent hemorrhagic disease of the newborn but cannot prevent tetanus.
Answer 4: Improved maternal nutrition, while important for fetal health, is less likely to prevent tetanus than maternal vaccination.
Answer 5: The vignette described a case of neonatal tetanus, which is not a genetic disorder, and thus genetic counseling would not be directly helpful.
Murphy TV, Slade BA, Broder KR, Kretsinger K, Tiwari T, Joyce PM, Iskander JK, Brown K, Moran JS. Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2008 May 30;57(RR-4):1-51.
PMID:18509304 (Link to Abstract)
Khan AA, Zahidie A, Rabbani F. Interventions to reduce neonatal mortality from neonatal tetanus in low and middle income countries--a systematic review. BMC Public Health. 2013 Apr 9;13:322. doi: 10.1186/1471-2458-13-322.
PMID:23570611 (Link to Abstract)